Question 1

You are treating a patient who states that he has been short of breath for the past month. Tonight, his breathing just "got too bad" and he decided to call 911. The 67-year-old male is alert and oriented and has a patent airway. He is breathing 24 times per minute but appears to have an adequate tidal volume. His pulse is strong and regular, and his skin is warm. Vital signs are: pulse 92 beats per minute, respirations 22, blood pressure 128/66 mmHg, and SpO₂ 93% while on home oxygen at 2 lpm. What instruction would you give to your partner regarding this patient's care?

Accepted Answer

The patient's SpO₂ is only 93% while on home oxygen at 2 lpm, indicating a need for supplemental oxygen. However, his breathing appears to be adequate and he is hemodynamically stable. Starting with a low supplemental oxygen flow rate of 3 liters per minute through a nasal cannula would be appropriate to increase his oxygen saturation while avoiding potential complications from over-oxygenation. Referral to the patient's family doctor or the use of a nasal airway are not necessary at this time, and 15 lpm of oxygen would be excessive and could lead to carbon dioxide retention.

Question 2

A 4-year-old female is having great difficulty breathing. She is responsive to verbal stimuli and has an open airway. Her respiratory rate is 40 breaths per minute, and she has an SpO₂ reading of 88% while receiving high-concentration oxygen through a pediatric nonrebreather mask. Her pulse is rapid, and her skin cool to the touch. As a knowledgeable EMT, you would recognize what condition?

Accepted Answer

The child's symptoms indicate respiratory failure, not just distress, due to the high respiratory rate, low SpO₂ despite high-concentration oxygen, rapid pulse, and cool skin. These signs suggest the body is not adequately oxygenated, indicating a failure in the respiratory system's function.

Question 3

On scene, you find a 2-year-old male in significant respiratory distress. He is responsive to verbal stimuli and exhibits noisy respirations through an open airway. His breathing is shallow at a rate of 44 breaths per minute. His pulse is rapid. Assessment of the skin shows it to be cool and diaphoretic with cyanosis to the extremities and around the mouth. What is the immediate priority for this patient?

Accepted Answer

The immediate priority for a patient in significant respiratory distress with shallow, rapid breathing and signs of inadequate oxygenation (e.g., cyanosis) is to ensure adequate ventilation and oxygenation. Starting positive pressure ventilation addresses the need for both improved ventilation and oxygen delivery, especially in a pediatric patient showing signs of severe respiratory distress.

Question 4

A son has called 911 for his father, who is having difficulty breathing. On scene the 81-year-old patient is lethargic and lying on a couch in the living room and is in obvious respiratory distress. He is confused, but has an open airway. His respirations are 30 per minute and his skin is extremely diaphoretic with cyanosis in the fingertips. At this time, the EMT should:

Accepted Answer

The patient is in obvious respiratory distress with a high respiratory rate and cyanosis. Positive pressure ventilation should be initiated immediately to improve oxygenation and reduce the possibility of hypoxia causing further complications. Suctioning the airway and assessing breath sounds may also be necessary, but positive pressure ventilation takes priority. Determining the patient's past medical history may be important in the long-term management of the patient but is not urgent at this moment.

Question 5

You have been called for a patient who is complaining of shortness of breath. On scene you find the 41-year-old woman sitting upright in bed with nasal flaring and wheezing. A metered-dose inhaler (MDI) is lying on the nightstand next to her. To assist her with the MDI, which of the following criteria must be met?

Accepted Answer

The most important criteria for assisting a patient with an MDI is that it must be prescribed for the patient by their healthcare provider. Administering oxygen first may be beneficial for patients with severe respiratory distress, but it is not necessary in all cases. The pulse oximeter reading and mental status of the patient are also not relevant to administering an MDI.

Question 6

Your medical director's written protocol instructs you to obtain on-line medical direction prior to assisting a patient with a metered-dose inhaler (MDI). Given this protocol, you must contact:

Accepted Answer

According to the protocol, on-line medical direction must be obtained prior to assisting a patient with a MDI. Therefore, the best choice is to contact an emergency physician before assisting with the MDI.

Question 7

When assessing an adult patient with difficulty breathing, what sign or symptom would be of most concern?

Accepted Answer

Blue coloration to the lips may indicate cyanosis, which is a sign of inadequate oxygenation and is a serious concern in a patient with difficulty breathing. A high temperature, respiratory rate within a normal range, or cyanosis limited to the fingernails may also be important to note, but they are not as urgent as cyanosis of the lips.

Question 8

A 4-year-old boy in respiratory distress is sitting upright in bed and drooling. His mother states that he has been complaining of a sore throat throughout the day and tonight became severely short of breath and started drooling. He is alert with adequate breathing. His skin is hot to the touch. Vital signs are pulse 132, respirations 28, and SpO₂ 90% on room air. Which one of the following is your first action in caring for this child?

Accepted Answer

The first action should be to apply supplemental oxygen to improve the child's oxygen saturation level. This will help alleviate his respiratory distress. Suctioning may also be necessary, but not before oxygen administration. An oral airway and tongue depressor should not be used unless there is evidence of airway obstruction.

Question 9

A 6-year-old female is in respiratory distress and will not keep the nonrebreather face mask on her face. In this situation, the EMT should:

Accepted Answer

Having the mother hold the mask near the child's face can provide oxygen without causing further distress, which is important in managing a child who is resistant to wearing a mask directly.

Question 10

You have been dispatched for a young child with difficulty breathing. As you enter the apartment, which one of the following scene clues would best indicate that the patient is experiencing a problem in her upper airway?

Accepted Answer

Stridorous noises with inspiration are indicative of upper airway obstruction, as the air struggles to pass through a narrowed airway. Grunting with exhalation and audible wheezing on expiration are more indicative of lower airway problems such as asthma. Low-pitched sobbing and crying may not necessarily indicate a specific type of airway problem.

Question 11

A 36-year-old patient has overdosed on an unknown drug and is unresponsive. He is breathing shallowly at 6 times per minute. He has cyanosis around his lips and to his fingertips. His skin is cool to the touch, and his radial pulse is rapid. His breath sounds are diminished but clear. The EMT should recognize which one of the following respiratory conditions?

Accepted Answer

The patient is showing signs of hypoxia, which is a condition where there is an inadequate supply of oxygen to the body's tissues. Shallow breathing and cyanosis, which is a bluish discoloration of the skin, are common symptoms of hypoxia. Rapid pulse and cool skin may indicate shock, which can also be caused by hypoxia. Diminished breath sounds may also be a sign of decreased oxygenation.

Question 12

As you enter the living room of an adult patient who called 911 for shortness of breath, you observe the patient sitting upright in a chair with a panicked look on her face, struggling to breathe. Her breathing rate appears to be fast and tidal volume poor. You can hear rhonchi from her lungs without the aid of a stethoscope. Once at her side, you initial care should be to:

Accepted Answer

Assessing the airway is the first priority in any patient with respiratory distress.

Question 13

A 48-year-old male is short of breath and confused. His airway is open, and his breathing accelerated. A radial pulse is easily palpated. His skin is warm to cool and dry. Your partner reports the following vital signs: pulse 124 beats per minute, respirations 24, blood pressure 158/86 mmHg, and an SpO₂ at 89% on room air. His lung sounds indicate slight wheezing. Based on this information, the immediate threat to this patient's well-being is which one of the following conditions?

Accepted Answer

The immediate threat to this patient's well-being is hypoxia, as indicated by his low SpO₂ level of 89%. This should be the first concern and addressed immediately to avoid further deterioration of his condition. The elevated blood pressure, increased heart rate, and slight wheezing are secondary concerns that also require attention and treatment.

Question 14

You are called to a motor vehicle collision. A 26-year-old female states that she was unrestrained and struck the steering column with her chest after the car she was driving struck another from behind. She is somewhat confused, and complaining of chest pain and difficult and painful breathing when she inhales. Her airway is patent and her breathing is adequate. Assessment of the radial pulse reveals it to be rapid and very irregular and weak. She has cyanosis in her nose and finger tips. Her breath sounds are clear and equal and skin moist and pale. She informs you that she suffers from asthma and has a metered-dose inhaler (MDI). What is your best action in treating this patient?

Accepted Answer

The patient is showing signs of shock, likely due to internal bleeding from the chest injury. The irregular and weak pulse, cyanosis, and pale skin all indicate poor perfusion. Applying supplemental oxygen can help improve oxygenation and perfusion until the patient arrives at a hospital for definitive treatment. The use of CPAP is not indicated in this case, as the patient's breath sounds are clear and equal. Transporting the patient in a position of comfort may worsen her condition if she has internal injuries. While assisting with the patient's MDI may be helpful for her asthma, it is not the priority in this situation.

Question 15

You have been called for a 2-year-old male who is sick and having a difficult time breathing. On scene, you find the patient in his mother's arms. He appears to have labored breathing and skin that is warm to the touch. What additional assessment finding would you recognize as the most serious?

Accepted Answer

The grunting noise heard as the child exhales is a significant finding in a child with difficulty breathing. It indicates an attempt by the child to increase their lung volume and maintain airway pressure, which can be a sign of impending respiratory failure. A respiratory rate of 28 breaths per minute and slight abdominal movement with breathing may be present in a child with labored breathing, while continual crying and a low-grade fever are non-specific symptoms.

Question 16

A confused and cyanotic patient is breathing 8 times per minute with poor chest rise and fall. What instruction would you give your partner about the respiratory care of this patient?

Accepted Answer

The patient is showing signs of inadequate ventilation (confusion, cyanosis, low respiratory rate with poor chest rise and fall), indicating the need for assisted ventilation. Ventilating at 10 to 12 times per minute, as stated in option B, is appropriate to ensure the patient receives adequate oxygenation and ventilation without waiting for the patient to initiate breaths, which may be insufficient.

Question 17

Auscultation of breath sounds in a patient complaining of shortness of breath reveals wheezing. Which one of the following conditions is responsible for this finding?

Accepted Answer

Wheezing is a high-pitched whistling sound that occurs during breathing due to the narrowing or constriction of the bronchioles. This can be caused by conditions such as asthma, chronic obstructive pulmonary disease (COPD), or bronchitis. Significant hypoxia may cause decreased breath sounds or crackles, while swelling in the throat may cause stridor. Mucus in the lungs may cause crackles or rhonchi.

Question 18

A 911 call was placed for a 3-year-old child with difficulty breathing. On scene you note that the child is upright with slight stridor upon inspiration. He is alert and breathing at a rate of 30 breaths per minute. His skin is warm and dry, and his radial pulse strong and regular. His breath sounds are clear and equal. His mother states that he has been fine all day until 15 minutes ago when he was playing with friends in the playroom and suddenly started having difficulty breathing. As an EMT, you should suspect which of the following conditions?

Accepted Answer

The sudden onset of breathing difficulty in a child who was previously fine, especially while playing, strongly suggests a foreign body airway obstruction. The presence of stridor (a high-pitched sound during breathing) also supports this diagnosis.

Question 19

Following a call in which you treated a pediatric patient suffering from croup, a new EMT who is in orientation asks you how you can differentiate croup from epiglottitis. Which one of the following responses would be most appropriate?

Accepted Answer

The best response is option D because it accurately differentiates croup from epiglottitis. Children with epiglottitis often drool due to difficulty swallowing, while children with croup do not. The other options are incorrect. Swelling associated with epiglottitis is not relieved by exposure to cool air, and both croup and epiglottitis can cause coughing. Additionally, croup is typically associated with a stridor, not wheezing, while epiglottitis may cause crackles in the lungs.

Question 20

When assessing a patient complaining of shortness of breath, which of the following actions should the EMT perform first?

Accepted Answer

The first action the EMT should perform is to assess the adequacy of the patient's breathing. This will help determine the severity of the shortness of breath and whether immediate intervention is necessary. Once the breathing is assessed, then the EMT can proceed with determining the cause of the shortness of breath and implementing appropriate interventions. Ascertain whether the patient has used an MDI and getting the patient's SpO₂ to 100% are important interventions, but they should not be performed before assessing the adequacy of the patient's breathing.

Quiz 16: Respiratory Emergencies

Your medical director's written protocol instructs you to obtain on-line medical direction prior to assisting a patient with a metered-dose inhaler (MDI) . Given this protocol, you must contact: